Finocchiaro Gherardo, Haddad Francois, Pavlovic Aleksandra, Magavern Emma, Sinagra Gianfranco, Knowles Joshua W, Myers Jonathan, Ashley Euan A
Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA Stanford Cardiovascular Institute, Stanford Cardiovascular Medicine, Stanford, California, USA.
BMJ Open. 2014 Jun 12;4(6):e004814. doi: 10.1136/bmjopen-2014-004814.
It is unclear if morphology impacts on diastole in hypertrophic cardiomyopathy (HCM). We sought to determine the relationship between various parameters of diastolic function and morphology in a large HCM cohort.
Tertiary referral centre from Stanford, California, USA.
383 patients with HCM and normal systolic function between 1999 and 2011. A group of 100 prospectively recruited age-matched and sex-matched healthy participants were used as controls.
Echocardiograms were assessed by two blinded board-certified cardiologists. HCM morphology was classified as described in the literature (reverse, sigmoid, symmetric, apical and undefined).
Reverse curvature morphology was most commonly observed (218 (57%). Lateral mitral annular E'<12 cm/s was present in 86% of reverse, 88% of sigmoid, 79% of symmetric, 86% of apical and 81% of undefined morphology, p=0.65. E/E' was similarly elevated (E/E': 12.3±7.9 in reverse curvature, 12.1±6.1 in sigmoid, 12.7±9.5 in symmetric, 9.4±4.0 in apical, 12.7±7.9 in undefined morphology, p=0.71) and indexed left atrial volume (LAVi)>40 mL/m(2) was present in 47% in reverse curvature, 33% in sigmoid, 32% in symmetric, 37% in apical and 32% in undefined, p=0.09. Each morphology showed altered parameters of diastolic function when compared with the control population. Left ventricular (LV) obstruction was independently associated with all three diastolic parameters considered, in particular with LAVi>40 mL/m(2) (OR 2.04 (95% CI 1.23 to 3.39), p=0.005), E/E'>15 (OR 4.66 (95% CI 2.51 to 8.64), p<0.001) and E'<8 (OR 2.55 (95% CI 1.42 to 4.53), p=0.001). Other correlates of diastolic dysfunction were age, LV wall thickness and moderate-to-severe mitral regurgitation.
In HCM, diastolic dysfunction is present to similar degrees independently from the morphological pattern. The main correlates of diastolic dysfunction are LV obstruction, age, degree of hypertrophy and degree of mitral regurgitation.
目前尚不清楚肥厚型心肌病（HCM）的形态学是否会影响舒张功能。我们试图在一个大型HCM队列中确定舒张功能的各种参数与形态学之间的关系。
美国加利福尼亚州斯坦福的三级转诊中心。
1999年至2011年间383例收缩功能正常的HCM患者。一组100名前瞻性招募的年龄和性别匹配的健康参与者作为对照。
由两名经过盲法评估的具备委员会认证的心脏病专家对超声心动图进行评估。HCM形态学按照文献中描述的进行分类（反曲型、乙状结肠型、对称型、心尖型和未定型）。
最常观察到的是反曲型形态（218例（57%））。二尖瓣环外侧E'<12 cm/s在反曲型中占86%，乙状结肠型中占88%，对称型中占79%，心尖型中占86%，未定型中占81%，p = 0.65。E/E'同样升高（E/E'：反曲型为12.3±7.9，乙状结肠型为12.1±6.1，对称型为12.7±9.5，心尖型为9.4±4.0，未定型为12.7±7.9，p = 0.71），且左心房容积指数（LAVi）>40 mL/m²在反曲型中占47%，乙状结肠型中占33%，对称型中占32%，心尖型中占37%，未定型中占32%，p = 0.09。与对照人群相比，每种形态学均显示舒张功能参数发生改变。左心室（LV）梗阻与所考虑的所有三个舒张参数均独立相关，特别是与LAVi>40 mL/m²（比值比2.04（95%置信区间1.23至3.39），p = 0.005）、E/E'>15（比值比4.66（95%置信区间2.51至8.64），p<0.001）和E'<8（比值比2.55（95%置信区间1.42至4.53），p = 0.001）相关。舒张功能障碍的其他相关因素包括年龄、LV壁厚度和中重度二尖瓣反流。
在HCM中，舒张功能障碍在相似程度上独立于形态学模式存在。舒张功能障碍的主要相关因素是LV梗阻、年龄、肥厚程度和二尖瓣反流程度。
